Five Cases of Lyme Carditis in Canada: Multiple Hospital Visits to Diagnose

Lyme carditis diagnosis delay can lead to repeated emergency visits, worsening heart block, and avoidable pacing procedures.

Lyme carditis with heart block can present with nonspecific symptoms and be difficult to diagnose. But early recognition matters. “Recognizing this early would curtail the progression of conduction disorders and potentially avoid permanent pacemaker implantation,” writes Wan from Queen’s University in Ontario, Canada.

Multiple Hospital Visits Before Diagnosis

The majority of patients in this case series — 3 out of 5 — visited the emergency room multiple times before the diagnosis was made. Two patients were diagnosed on their second visit, while one was not recognized until the fourth visit.

This pattern highlights how easily Lyme carditis can be missed when symptoms are attributed to more common conditions.

Serious Conduction Abnormalities

According to Wan, “Three patients presented complete AVB whereas the other 2 developed second-degree atrioventricular block with 2:1 conduction.”

These are potentially dangerous cardiac findings that can progress rapidly if Lyme carditis is not recognized and treated.

Temporary Pacing, But No Permanent Pacemakers

None of the five patients required a permanent pacemaker. However, two required temporary pacing. “Temporary pacing was indicated according to hemodynamic tolerance to bradycardias,” Wan explains.

Echocardiograms also showed abnormalities in two patients, including mild right ventricular dilation in one and focal myocarditis with diastolic dysfunction in another.

Antibiotic Treatment Reversed the Heart Block

Four patients were treated with intravenous ceftriaxone until the heart block resolved, followed by oral therapy. The remaining patient was treated with doxycycline.

Conduction abnormalities resolved in all five patients within 1 to 2 weeks after starting antibiotics.

Young Males Without Classic Lyme Signs

All five patients were males younger than 35 years old. The youngest was 14 years old. All had participated in outdoor activities in endemic areas.

But only three remembered a tick bite, and only one had an erythema migrans rash. All did, however, have systemic symptoms such as fatigue, fever, headache, neck stiffness, nausea, arthralgia, myalgia, or flu-like illness.

Why Lyme Carditis Is Missed

The authors warn that “the absence of pathognomonic EM, presentation with nonspecific symptoms and involvement of various systems, all can potentially distract a physician from making the correct diagnosis at initial presentation.”

The correct diagnosis, they note, may spare patients the risks of pacemaker implantation, later complications, repeated generator replacements, and substantial long-term healthcare costs.

Clinical Takeaway

Lyme carditis diagnosis delay can lead to repeated ER visits and worsening heart block. Clinicians should consider Lyme carditis early in young patients from endemic regions with unexplained conduction abnormalities, even when no tick bite or rash is reported.

Related Articles:

Lyme carditis causes complete heart block in 26-year-old man

Temporary pacemaker effective in acute Lyme carditis patient with severe heart block

When Lyme disease mimics a heart attack

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